The present disclosure generally relates to surgical instruments for use in surgical procedures. In particular, a sleeve suitable for suprapatellar surgery and a system comprising the sleeve are described.
When treating a tibial fracture (e.g., for realigning the tibia), a patient's knee is typically flexed approximately 90° in order for the surgeon to get access to the top of the tibia in front of the patella for inserting an implant such as an intramedullary nail for fracture fixation. However, patients report frequently on high rates of anterior knee pain caused by the common infrapatellar nailing procedure.
A so-called suprapatellar approach for intramedullary nailing of tibial fractures may be used by surgeons, since it provides first evidence of reduced anterior knee pain and thus enhanced clinical outcome. During suprapatellar surgery, a drill sleeve is inserted between the patella and the femur of the patient's knee and the necessary flexion of the knee joint may consequently be significantly less than 90°. Nonetheless, as suprapatellar surgery is performed through a, supposedly, healthy joint (patellofemoral joint), the joint surfaces need to be protected during the surgery.
DE 10 2008 004 922 A1 discloses a device for bone surgery close to a joint of the bone. The device comprises a sleeve with a central opening and a cylinder with a plurality of canals for insertion of wires. The cylinder is adapted to enclose the sleeve.
It has been found that the device of DE 10 2008 004 922 A1 is over-dimensioned for suprapatellar surgery. If all dimensions of the device were proportionally decreased, the maximum size of a drill (and an implant) that need to be introduced through the device would be compromised at the cost of an inferior recovery procedure.
It has further been found that the presence of canals inside the cylinder walls complicates cleaning and sterilization of the cylinder. This complication is due to the fact that tissue debris may adhere to the inner surfaces of the canals. Additionally, anterior displacement of the cylinder is likely to occur which can lead to unnecessary iatrogenic injuries.
Instruments for use in tibial nailing are shown in U.S. Pat. Nos. 7,476,225 and 8,328,805.